Live births spatial distribution, distance from home to hospital delivery and neonatal mortality in São Paulo City, 2008

Abstract

Sao Paulo is a megacity presenting a heterogeneous spatial occupation and not always the urban infrastructure is adequate to meet all the needs of the population. Private services highly complex are located next to primary care health services, which do not always have the basic resources, resulting in different living conditions that can result in unequal health situations, including different epidemiological profiles of births and neonatal deaths.The project aims to: describe the profile of clusters of live births in São Paulo, according to maternal characteristics (education, parity, marital status and age), characteristics of pregnancy and childbirth (length of gestation and type of delivery) and newborn (birth weight); to observe flow differences from mothers residence to hospitals, according to characteristics of clusters of birth and type of hospitals; to identify possible differences on probability of neonatal death according to clusters of birth; to evaluate if there is an association between the flow of mothers to hospital delivery and neonatal mortality in São Paulo in 2008.This will be an ecological study. Clusters of births will be considered as the unit of analysis and will be obtained from geo-referencing of addresses of residence of mothers. The study population will be live births from resident mothers in São Paulo municipality in 2008. Information on maternal characteristics and newborn, the residence of the mothers and hospital's delivery addresses will be obtained from the live birth and neonatal death certificates, this data will be obtained in SEADE. Information about the type of hospital (number of beds, entity sponsor, presence of adult and neonatal intensive care unit) will be obtained from the National Health Services Registry. A linkage of the databases of neonatal deaths and live birth certificates will be carried out in order to obtain the probability of death of birth clusters. The geocoding of addresses will be accomplished through geographically digitized administrative districts of São Paulo and the limits of the municipality of São Paulo. The clusters of births will be identified with the use of kernel intensity estimator, employing the free TerraView 3.6.0 software. The identification of flow from mothers residence to the delivery hospitals will be performed by calculating the theoretical distance (straight line) in km, between the birth addresses of hospitals and home addresses mothers, which is obtained as a weighted average of the distances between the residences (each cluster) and the delivery hospitals will be calculated through ArcInfo10 software. A descriptive analysis of the profile of clusters of birth will be carried out. The association between the average distances to the clusters of hospital births will be tested. The possible association between household / hospital flows and the probability of neonatal death will also be assessed. Statistical analysis will be done using the R-project and Stata 10 2.11.0 software. (AU)